Caring for US Veterans Helped Lead Iraqi Immigrant to Develop Prostate Cancer Advances

Maha H. Hussain, MB ChB

Life hasn’t always gone as planned for Maha H. Hussain, MB ChB.

When she graduated from Baghdad University College of Medicine in June 1980, Hussain thought she had everything figured out. She would complete her residency at the main teaching hospital in Baghdad and then join her new husband, also a doctor, who was heading to England for a few years, to finish their training. After specialization, the two would start their careers in Iraq. Hussain had her heart set on becoming a hematologist.

But the start of the Iraq-Iran war changed everything.

“We began hearing about the troops amassing on the borders between Iraq and Iran. Literally, within 3 days, I had to decide if I was going to join my husband and leave Iraq for England,” said Hussain. “This was the era of Saddam Hussein and all the political unrest and brutality of the regime. It was a lot of pressure to decide what to do, but we could sense that a war was coming.”

Finding Her Inspiration

Hussain made the difficult decision to leave her home in August 1980, escaping just 5 weeks before the war began. The couple planned to return and rebuild their lives in Baghdad once it was safe again. That day never came.Today, Hussain is internationally known as a leader in clinical research in the field of genitourinary (GU) cancers, where her work has led to changing the standards of care for patients with metastatic prostate cancer.

Her latest position of leadership will be as the associate director for Clinical Sciences Research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, where she also will serve as co-director of the center’s Genitourinary Oncology Program.

Hussain has been serving in a similar position at the University of Michigan Comprehensive Cancer Center, which she joined in 2002. She is the Cis Maisel Professor of Oncology, associate director for clinical research, co-leader of the Prostate Cancer/GU Oncology Program.

“I am first and foremost a physician,” said Hussain. “I’ve also been fortunate to be able to participate and lead clinical trials, translating the ideas that I’ve come up with both at the national and international levels.”

“We have been able to affect the field in terms of managing advanced prostate cancer and really push the envelope with regard to developing new treatments. I am proud of that,” she said.

Getting to where she is today did not come without its challenges. A few years after leaving Baghdad for England, Hussain and her husband made another international move, this time to the United States. One of Hussain’s uncles, who was also a doctor, lived in Michigan, so the couple settled there in 1983. At the time, there were not many other people of Middle Eastern descent in Michigan.

“It was not very easy to establish another new life in another foreign country,” said Hussain. “However, very soon after arriving, we ended up loving Michigan and the United States, the people, and the style of living. You could make friends easily and integrate. Although the language and the society culture are different, people are the same everywhere.” After completing her training at Wayne State University, Hussain took a job as a staff physician in the Hematology and Oncology Department of the VA Medical Center in Detroit, where she stayed for 10 years. Working with veterans was an experience that had a significant impact on her life, both personally and professionally, said Hussain.

When she first started at the VA, Hussain wasn’t sure how her patients, many of whom served in the military in the Middle East, would respond to a female Iraqi physician.

“My last name, Hussain, sounds the same as Saddam Hussein,” said Hussain. “You can get singled out immediately as a foreign person with a funny name and a name that is not really favorable because of its similarity with an evil person’s name.” But her patients’ reaction to her ethnicity surprised her.

“Not only were these men supportive of me as their doctor and allowed me to take care of them, but they showed genuine concern about my family who were still in Iraq,” she said. “People wrote me letters, telling me not to worry, reassuring me that they had my family in their thoughts and they were praying for my family. It wasn’t just patient to doctor, it was human being to human being, and that was amazing.”

That strong connection with her patients who were military veterans, many who were fighting losing battles with GU malignancies, motivated Hussain to refocus her career goals.

“At the time I started, there weren’t that many research opportunities or treatment opportunities within GU malignancies,” said Hussain.

“I became really fascinated by the biology of prostate cancer and how little we had to offer patients with metastatic disease.”

At the time, prostate-specific antigen testing was just beginning to become more commonplace, said Hussain. Many of her patients presented with advanced cancer and had limited treatment options. Hussain made it her goal to discover novel treatments that offered hope to these patients.

“I started my career in the laboratory asking questions about micrometastases in the setting of prostate cancer,” she said. “I published on the subject early in my career. As I got more involved with patients, I became more interested in clinical research. Ultimately, my goal was and is to help patients.”

Her contributions as a clinical researcher and leader led in part to the 2004 FDA approval of docetaxel, the first drug to demonstrate a significant survival advantage for men with advanced resistant prostate cancer.

She has also led studies that defined the role of intermittent androgen deprivation therapy and, more recently, was part of the team that demonstrated docetaxel’s significant survival impact in patients with hormone-sensitive metastatic prostate cancer.

Hussain, in collaboration with colleagues across the country, has also facilitated national research through various leadership positions including as co-chair of the Prostate Cancer Subcommittee of the Southwest Oncology Group (SWOG) GU committee.

She has served as a member for several years on the Integration Panel of the US Army Medical Research and Materiel Command Prostate Cancer Research Program and as its 2013 chair, and as a member of the National Cancer Institute’s prostate cancer task force, among other scientific leadership roles.

Working in a "Man's World"

At the University of Michigan, Hussain launched first-of-their-kind clinical trials investigating novel therapeutic targeting of molecular alterations in prostate cancer. On top of her research contributions, she also teaches, mentors, and continues to see patients, primarily those with prostate and/or bladder cancers.Being a female GU specialist has also presented some unique challenges of its own. When Hussain first started working with prostate cancer and other GU patients, she could count on one hand the number of other women in her industry.

“There was a perception that maybe women can’t deal with male-type malignancies,” she said. “It can be challenging trying to manage male-related disease with all of the issues involved with it—impotency, incontinence, etc— issues some patients could be uncomfortable talking about with a female doctor.”

Despite this, Hussain said she was welcomed with open arms by both the patients and her male colleagues.

“My interactions over the decades have been wonderful,” she said. “I do not feel, by any means, that because I am a woman that my patients did not value my expertise and care or that my colleagues valued me any less.”

Today, there are a growing number of women entering the GU field.

Evolution of Prostate Cancer Treatment

“What I tell other women is the most important thing is that you love what you do and that you are passionate about it,” said Hussain. “You have to be attracted to the field itself. The fact that you’re a woman or a man, it doesn’t really matter. What people are looking for is the human side and the intellectual side of the person who can contribute to science and patient care.”The treatment of prostate cancer has come a long way since Hussain began her career. In the 1980s and 1990s, she recalled telling patients with metastatic disease that they would not likely live more than 2 years.

“When I was a resident, we had patients being admitted through the emergency room that were diagnosed there with what appeared to be metastatic prostate cancer,” she said. “The cancer would respond to hormone treatment, but at the time, the main hormone treatment was actually surgical castration, and the minute the cancer became resistant to hormone treatment, patients had, on average, only 9 months left to live.”

Today patients with new metastatic disease are likely to live an average of 4 years, and when the cancer becomes resistant to hormone treatment, there are multiple options available to them.

Despite advances, however, more than 27,000 men per year still die from prostate cancer, said Hussain, so much more work needs to be done. Survivorship and quality-of-life issues also need more attention, as men are living longer with the disease. The understanding of prostate cancer has become more advanced in recent years, said Hussain.

“We are really starting to understand the complexity of prostate cancer and why it is that some cancers are resistant to certain treatments,” she said. “The investment in research and the partnership with patients in clinical trials makes it possible to change prostate cancer into a chronic disease with the hope of a cure. I think that can be a reality in the near future, hopefully before I retire.“

Future goals for Hussain outside of work include continuing her hobbies of reading, gardening, photography, cooking, traveling, and spending time with her husband, her two grown children, family, and friends. She is still in touch with family and friends in Iraq, Europe, and the United States, and has even reconnected with her medical school class of 1980 via Facebook, despite never being able to return because of safety issues.

Hussain hopes to someday return to Iraq and contribute in whatever way she can. She has an immense respect for the people who work and live there despite its challenges, but said that after more than 30 years of living here, the United States is home.

“Some of the choices that I’ve made were difficult, but I think leaving Baghdad when I did and coming to the United States were the best decisions I’ve made,” she said. “I have been so fortunate here to have the opportunity to work with talented teams locally and nationally with the ultimate goal of making a real impact on our patients’ lives. I think there must have been a higher power watching over me."